Reblog – Former Westmead Student talks to ACEM

Cameron Spenceley features in this months ACEM college update – his article giving insights into rural medicine is below

The Night Watch

The only doctor on duty at night for an area the size of the UK. It’s a nightmare for some, but for Cameron Spenceley, it’s a dream come true.

When you’re on the night shift in Tennant Creek, you’re the only doctor awake and on duty for 240,000 square kilometres.

The next hospital is 510 kilometres away in Alice Springs. In between and all around, the Barkly Tablelands offer a vast expanse of red dirt, grassy plains, 46 degree heat and a local population that would barely fill the Sydney Opera House.

For some this might sound daunting but for Dr Cameron Spenceley, it’s exactly the kind of place he wants to be.

“It’s the happiest place I’ve ever been in terms of work,” he says, “I can’t really put my finger on why. There’s no good coffee or opera or AFL and it’s hot and it’s dusty but it’s just utterly unique. One large hospital is much like another in many ways, but the smaller the hospital gets, the more unique it is. I think it helps that you’re a real part of the community from the day you arrive.”

Tennant Creek Hospital’s emergency department sees 12,000 patients a year. Complex, high acuity patients are common and historically the hospital had relied on frequent aeromedical transfers. Two federally funded programs, along with dedicated doctors at Alice Springs and Tennant Creek, have helped transform emergency care at the hospital in recent years.

Alice Springs Hospital’s EMET program has enabled a rotating FACEM workforce at Tennant Creek Hospital every second week since 2012. This FACEM presence led to the uptake and completion of the EM Certificateby two doctors at Tennant Creek and planted the seed for establishing an ACEM training position.

In 2014 the hospital applied for accreditation for a 3-6 month Rural and Remote Health term. They were able to place their first ACEM trainees at the hospital in 2015 through the Specialist Training Programme. Dr Spenceley is one of the first cohort of ACEM specialist trainees at Tennant Creek.

While Dr Spenceley is more than willing to shoulder the responsibility that comes with his role, he’s not entirely without support. There is always a senior doctor on call for help, particularly in the middle of those long night shifts.

“If something happens overnight, the FACEM will always come in even though they’ve been working that day and the senior doctor who is a FACCRM will also come in,” Dr Spenceley says. “That will certainly happen in a run of night shifts in my experience, where you need more than one senior doctor if you have very unwell patients in the ED.”

Dr Spenceley agrees that Tennant Creek is a great place to learn how to multitask.

EM trainees are expected to assist with both the emergency beds and the inpatient ward in the hospital. A typical shift can and will include anything from doing your own admissions – as there is no medical registrar – to helping preparing a body for post-mortem transfer to the morgue. On top of this there are also a considerable amount of critically ill patients that need to be treated.

“The unwell paediatric patients are, I think, the most stressful for both junior and senior Doctors,” Dr Spenceley says, “For the minor cases, you deal with them yourself and these are at a level you would see in a major ED, but it’s common in a shift to have at least one or two seriously ill patients who need Royal Flying Doctor Service transfers.”

Tennant Creek Hospital has only 20 beds which means it can get easily overwhelmed if there is a sudden outbreak or major trauma incident, or even if there are a lot of minor incidents that happen all at once.

“You’ve only got to have 40 unwell people in the town and you’ve completely swamped the health service – it’s not difficult to do,” Dr Spenceley says, “The nearest hospital is 500km away so we don’t have the option to go onto ambulance bypass. We’ve had some stressful nights.”

The complexities of diversity

One of Dr Spenceley’s passions is Indigenous health and he regards it as one of the most significant parts of working at Tennant Creek. The town has a very diverse population compared to most Australian towns, with 30 percent of citizens identifying as Indigenous, and 20 percent of the population born overseas. Over 80 percent of its ED presentations are by Indigenous patients.

In terms of healthcare and treatment this means cultural competency is absolutely key to treating patients. Dr Spenceley is adamant that a respect for and understanding of local culture and practices is essential to providing treatment in an Indigenous setting. This often means working with Indigenous liaison officers and social workers to ensure that everyone gets a voice in the medical environment.

For Dr Spenceley these cultural differences are most apparent when it comes to Indigenous approaches to palliative care.

“The people you look after until death are the most memorable, and for many it is important to spend their last days here rather than a big hospital,” he says, “The most significant lesson I have learned from those patients is the importance in Indigenous culture of the extended family. The number of times you see 20 or more people crammed into a small hospital room for hours on end visiting a relative is incredible.”

A town like Tennant

Dr Spenceley grew up in Sydney and spent most of his life there. He freely admits that it took a real leap of faith to come to somewhere as remote as Tennant Creek. Despite all the uncertainty, his experiences have been overwhelmingly positive. While he now has to continue his ACEM training at a larger hospital, he is keen to come back to Tennant Creek once he achieves Fellowship, if he can.

He notes that getting out and exploring the beautiful local landscape helped him to feel at home, as well as getting involved in local life such as joining the local gym run by the Aboriginal health organisation. While Tennant Creek is geographically isolated, there is a very strong community of people there who make a point of looking out for each other.

For local doctors in particular this means you get the unique privilege of running into your patients at the local shops.

“Just this morning I went to the shop and there were three of my patients there,” Dr Spenceley says. “It happens every day. They all talk to you, about life not just medical things, and I think that has to be the way you do it up here. Getting to know the community, the land and the people is vital.”